Erythemal UV Radiation on Days with Low UV Index Values—an Analysis of Data from the German Solar UV Monitoring Network over a Ten‐year Period

According to the World Health Organization and partner organizations, no protection against ultraviolet (UV) radiation is required on days with “low” values (i.e., values <3) of the Global Solar Ultraviolet Index (UVI). Erythemal irradiance (E_er) data of such days were analyzed to evaluate this claim. Measurements from 9 stations of the German solar UV monitoring network from 2007 to 2016 yielded 14,431 daily E_er time series of low UVI days. Erythemal doses for certain fixed time intervals—acquired from measurements on horizontal planes—were compared with the average minimal erythemal dose (MED) of skin phototype II. Doses from days with rounded UVI values of 0 were insufficient to induce erythema and even on days with rounded UVI values of 1 doses exceeding 1 MED of skin type II could only be acquired under very specific circumstances of prolonged exposure. Conversely, sun exposure on days with rounded UVI values of 2 can indeed provide doses sufficient to induce erythema in skin type II after two hours around noon. In conclusion, our analyses do not support the claim of harmlessness currently associated with the entire low UVI exposure category in public guidance on interpretation of the UVI.     

Global Solar UV Index: Australian measurements, forecasts and comparison with the UK

The 2002 revision of the UV index (UVI) issued by the World Health Organisation (WHO), the World Meteorological Office (WMO), the United Nations Environment Programme (UNEP) and the International Commission on Non-Ionizing Radiation Protection (ICNIRP) (World Health Organization [2002] Global Solar UV Index: A Practical Guide. WHO, Geneva) was motivated by the need to further standardize the use and presentation of the UVI. Awareness of the hazards of solar UV radiation (UVR) is generally high in Australia, but more effective use of the UVI will assist in promoting further changes to the population's sun exposure behavior. UVI levels for a number of cities around Australia as measured by the Australian Radiation Protection and Nuclear Safety Agency (ARPANSA), covering the time period 1996-2000, are presented. Also shown are UVI forecasts from the Australian Bureau of Meteorology (BOM). Agreement between the BOM data and the measurements varies depending on the location but is within 2 UVI units approximately 75% of the time. UVI levels are supplied to the media, and in summer values in excess of 12-14 are regularly recorded, although the more northerly locations occasionally reach 16 and 17. The factors affecting the solar UVR environment and the measured UVI are also discussed and compared against measurements from the UK.     

An overview of the ultraviolet index and the skin cancer cases in Brazil

This study relates regional and seasonal UV index (UVI) variations, number of skin cancer cases and population skin-color distribution in Brazil. UVI calculations were performed using the UV Global Atmospheric Model (UVGAME), whose characteristics and validations are provided in thiis article. Health and racial data sets are based on the health and census data collected by Brazilian governmental agencies in the past. The discussion covers cultural customs and details of health and educational campaigns in Brazil. Despite lower UV levels in the South and Southeast regions, the results show a number of nonmelanoma skin cancer (NMSC) cases regions, where the white population is predominant. In general, in the southern regions about 50 new NMSC cases per 100000 inhabitants have been diagnosed each year. These rates decrease almost 40% in the Central-North regions and more than 80% in Northeast region, where miscegenation is common. In addition, the UVI evaluation is extended to other South American sites with singular characteristics, e.g. populous cities located in high altitudes or those affected by the Antarctic ozone hole in the extreme south of the continent.     

Vitamin D and Skin Cancer

Vitamin D signaling plays a key role in many important processes, including cellular proliferation, differentiation and apoptosis, immune regulation, hormone secretion and skeletal health. Furthermore, vitamin D production and supplementation have been shown to exert protective effects via an unknown signaling mechanism involving the vitamin D receptor (VDR) in several diseases and cancer types, including skin cancer. With over 3.5 million new diagnoses in 2 million patients annually, skin cancer is the most common cancer type in the United States. While ultraviolet B (UVB) radiation is the main etiologic factor for nonmelanoma skin cancer (NMSC), UVB also induces cutaneous vitamin D production. This paradox has been the subject of contradictory findings in the literature in regards to amount of sun exposure necessary for appropriate vitamin D production, as well as any beneficial or detrimental effects of vitamin D supplementation for disease prevention. Further clinical and epidemiological studies are necessary to elucidate the role of vitamin D in skin carcinogenesis.     

Sun Exposure over a Lifetime in Australian Adults from Latitudinally Diverse Regions

Spatio‐temporal patterns in sun exposure underlie variations in skin cancer incidence and vitamin D deficiency, indicate effectiveness of sun protection programs and provide insights into future health risks. From 558 adults across four regions of Australia (Brisbane (27°S), Newcastle (33°S), Geelong and the Western Districts of Victoria (37°S) and Tasmania (43°S)), we collected: self‐report data on time‐in‐the‐sun from age 6 years; natural skin color and ethnicity; silicone skin casts (for cumulative skin damage); and serum for vitamin D status. Ambient ultraviolet radiation (UVR) at the location of residence, with time‐in‐the‐sun, was used to calculate a “UVR dose” for each year of life. Individuals maintained their ranking compared to their peers for time‐in‐the‐sun in summer compared to winter and across ages (Spearman rho 0.24–0.84, all P < 0.001). Time‐in‐the‐sun decreased with age in all birth cohorts, and over calendar time. Summer time‐in‐the‐sun increased with increasing latitude (P < 0.001). Seasonal variation in vitamin D status had greater amplitude and vitamin D deficiency increased with increasing latitude. Temporal patterns are consistent with effectiveness of sun protection programs. Higher relative time‐in‐the‐sun persists from childhood through adulthood. Lower summer time‐in‐the‐sun in the warmest location may have implications for predictions of UVR‐related health risks of climate change.     

How does the skin sense sun light? An integrative view of light sensing molecules

The consensus on the effects of excessive sun exposure on human health has long emphasized the negative effects of solar UV radiation. Nevertheless, although UV radiation has been demonized, less is known about the consequences of sun exposure while using sunscreen, which can lead to high visible light exposure. UV and visible light play key roles in vitamin D synthesis, reduction of blood pressure, among other beneficial effects. In this review, we aim to provide a comprehensive view of the wide range of responses of the human skin to sunlight by revisiting data on the beneficial and harmful effects of UV and visible light. We start by exploring the interaction of photons in the skin at several levels including physical (depth of photon penetration), chemical (light absorption and subsequent photochemical events), and biological (how cells and tissues respond). Skin responses to sun exposure can only be comprehensively understood through a consideration of the light-absorbing molecules present in the skin, especially the light-sensing proteins called opsins. Indeed, many of the cellular responses to sun exposure are modulated by opsins, which act as the “eyes of the skin”.     

Location and vitamin D synthesis: is the hypothesis validated by geophysical data?

The literature reports strong correlations between UV exposure and latitude gradients of diseases. Evidence is emerging about the protective effects of UV exposure for cancer (breast, colo-rectal, prostate), autoimmune diseases (multiple sclerosis, type II diabetes) and even mental disorders, such as schizophrenia. For the first time, the available levels of vitamin D producing UV or "vitamin D UV" (determined from the previtamin D action spectrum) and erythemal (sunburning) UV from throughout the USA are measured and compared, using measurements from seven locations in the USA are measured and compared, using measurements from seven locations in the US EPA's high accuracy Brewer Spectrophotometer network. The data contest longstanding beliefs on the location-dependence and latitude gradients of vitamin D UV. During eight months of the year centered around summer (March-October), for all sites (from 18 degrees N to 44 degrees N latitude) the level of vitamin D UV relative to erythemal UV was equal (within the 95% confidence interval of the mean level). Therefore, there was no measured latitude gradient of vitamin D UV during the majority of the year across the USA. During the four cooler months (November-February), latitude strongly determines vitamin D UV. As latitude increases, the amount of vitamin D UV decreases dramatically, which may inhibit vitamin D synthesis in humans. Therefore, a larger dose of UV relative to erythemal UV is required to produce the same amount of vitamin D in a high latitude location. However, the data shows that at lower latitude locations (<25 degrees N), wintertime vitamin D UV levels are equal to summertime levels, and the message of increasing UV exposure during winter is irrelevant and may lead to excessive exposure. All results were confirmed by computer modeling, which was also used to generalize the conclusions for latitudes from 0 degrees to 70 degrees N. The results of this paper will impact on research into latitudinal gradients of diseases. In particular, it may no longer be correct to assume vitamin D levels in populations follow significant latitude gradients for a large proportion of the year.     

Diurnal variation of ocular exposure to solar ultraviolet radiation based on data from a manikin head

Measurements were conducted at San Ya, China (18.4°N, 109.7°E, altitude 18 m) to investigate the diurnal variation of ocular exposure to ultraviolet (UV) radiation. The experimental apparatus was composed of a manikin and a dual-detector spectrometer to simultaneously measure ocular and ambient UV data. The experimental apparatus was rotated clockwise to simulate three different types of exposure. When the manikin was facing into the sun, the ocular exposure to UV radiation on a summer day was bimodally distributed. The maximum ocular UV irradiance occurred at solar elevations of around 40° and 50° for UVA and UVB respectively. The spectral irradiances were measured at specific wavelength to obtain the ocular biologically effective UV (UV(BE) ) irradiances for photokeratitis, photoconjunctivitis and cataract, and the UV index (UVI) was calculated at the same time point for comparison. When the manikin faced the sun, the maximal ocular UV(BE) irradiance values were obtained at the solar elevation where the UVI value was 8. The results of this study showed that protection against ocular overexposure during outdoor activities should be taken not only at noon but also at other times.     

Sensitivity of erythemally effective UV irradiance and daily exposure to temporal variability in total ozone

The provision of information to the public about current levels of the erythemally effective UV radiation is an important issue in health care. The quality of promoted values is therefore of special importance. The atmospheric parameter which affects the erythemally effective UV radiation under clear sky most is the total ozone content of the atmosphere. In this paper we examined the sensitivity of the erythemally effective irradiance and daily radiant exposure to the temporal variability of total ozone on time scales from 1 to 15 days. The results show that the sensitivity is highest for the first 24 h. Larger time scales do not exhibit a similar influence. Total ozone measurements of the previous day may already cause uncertainties higher than 0.5 UV index (UVI) independent of the geolocation. For comparison, a temporal persistence of 15 days may cause uncertainties of 1.2 UVI at 50°N, 1 UVI at 30°S and less than 1 UVI at the equator. The results of this study allow finding the necessary temporal resolution of total ozone values when a certain accuracy for the UVI or for the purpose of sun protection is required. The results are compared with those of two preceding studies where we quantified the influence of measurement uncertainties and spatial total ozone variability to the erythemally effective irradiance at noon and to the daily dose. We conclude that temporal variability of total ozone is the most critical issue, but also measurement uncertainties do have a noticeable influence on the erythemally effective radiation.     

Relationship between vitamin D status and skin phototype in general adult population

A link between bone mineral density and skin color has been reported recently, and pigmentation has been shown to affect cutaneous vitamin D production. In the present study, we investigated the relationship between phototype, global self-assessed sun exposure, geographical location and vitamin D serum levels in 1191 French adults. When the factors were analyzed separately, individuals with lower phototypes as well as those with lower sun exposure showed significantly lower levels of vitamin D than those with darker phototypes or those with higher sun exposure. However, when factors were analyzed as a whole, the vitamin D status was no longer linked with the phototype, but with sun exposure and geographical location. Since phototypes and global self-assessments of sun exposure were positively linked, our data suggest that lower vitamin D levels in fair-skinned individuals are due to their sun exposure behavior.     

Calculated ultraviolet exposure levels for a healthy vitamin D status

The dangers of overexposure to sunlight have been well publicized, but less attention has been given to an acknowledged benefit of exposure to UV radiation; that being the cutaneous synthesis of vitamin D3. Here we define a standard vitamin D dose on the basis of recently recommended requirements for vitamin D that take account of its risk reduction role in a variety of diseases, and present a web-based tool that enables the reader to calculate associated exposure times for any time and place using either default values or user-selected conditions. Either it is not possible to synthesize vitamin D3 at high latitudes in winter, or the exposure time required to reach a standard dose is sometimes impractical. Where solar UV is sufficient, a risk-benefit analysis of sunburn vs. vitamin D3 synthesis shows that the best time for brief sun exposure is in the middle of the day. For low solar elevation angles common at high latitudes, a fine line exists between adequate UV exposure for vitamin D3 synthesis and a risk of sun burn.     

Effect of Protective Measures on Eye Exposure to Solar Ultraviolet Radiation

In this study, ocular biologically effective exposure to solar ultraviolet radiation (UVBE) is investigated with six kinds of sun protective measures (spectacle lenses, sunglasses, cap, bonnet, straw hat and under parasol). Ocular UV exposure measurements were performed on manikins during the summer period in Shenyang city (41.64° N, 123.50° E, 66 m a.s.l.), China. The measurements include the ocular UV exposure of an unprotected eye and the ambient UV as a control concurrently. Based on the relative spectral weighting factors of the International Commission on Non‐Ionizing Radiation Protection (ICNIRP), the ocular biologically effective UV is calculated and compared with the 8‐h exposure limits of ICNIRP (30 J m^?2). The UV index (UVI) of the measurement days is 0–8, and the 8‐h (8:00–16:00 China Standard Time, CST) cumulated UVBE of the unprotected eye is 452.0 J m^?2. The 8‐h cumulated UVBE of the eye with spectacle lenses, sunglasses, cap, bonnet, straw hat and under parasol are 364.2, 69.1, 51.4, 49.0, 56.8 and 110.2 J m^?2, respectively. Importantly, it should be noted that the eye could be exposed to risk despite protective measures. The 8‐h cumulated UVBE of the eye with protection is ca 1.6–15.1 times the exposure limit, respectively. As indicated in the present study, during summer months, high exposure to the sun for more than 30 min without eye protection and more than 1 h with eye protection is not advisable. The protection measures could effectively reduce the UVBE reaching the eye, yet there is still a high degree of risk when compared with the ICNIRP 8‐h exposure limits.     

Sun beds and cod liver oil as vitamin D sources

The objective of this study was to (1) to determine the contribution of moderate sun bed exposure to serum 25(OH)D(3) levels; (2) to estimate the decay time of a high 25(OH)D(3) level obtained by sun bed exposure; and (3) to evaluate if the recommended ingestion of vitamin D is sufficient to maintain the 25(OH)D(3) concentration obtained by sun bed exposure. Ten volunteers (20-35 y.o.), skin type I and II, living in Olso, Norway were whole body exposed twice per week to the radiation of a commercial and approved sun bed (Life Sun S 100 W, Wolff System), starting with 0.5 MED (minimal erythema dose) and escalating to up to 1 MED per exposure for 4 weeks. After that, half of the volunteers were given a daily supplement of 200 IU vitamin D in the form of cod liver oil capsules, while the other half of the persons received no supplements. Erythema did not occur at any time and a slight pigmentation was seen in most of the volunteers after the sun bed exposures. Serum level of 25(OH)D(3) increased by about 40% on the average. The initial serum 25(OH)D(3) level was different among the volunteers (40-100 nmol/L). Within eight weeks after the last exposure the 25(OH)D(3) level decreased to the initial value in all volunteers irrespective of vitamin D supplementation or not.     

Self‐Reported Changes in Sun‐Protection Behaviors at Different Latitudes in Australia

Sun exposure is the most important source of vitamin D, but is also a risk factor for skin cancer. This study investigated attitudes toward vitamin D, and changes in sun‐exposure behavior due to concern about adequate vitamin D. Participants (n = 1002) were recruited from four regions of Australia and completed self‐ and interviewer‐administered surveys. Chi‐square tests were used to assess associations between participants' latitude of residence, vitamin D‐related attitudes and changes in sun‐exposure behaviors during the last summer. Multivariate logistic regression analyses were used to model the association between attitudes and behaviors. Overall, people who worried about their vitamin D status were more likely to have altered sun protection and spent more time in the sun people not concerned about vitamin D. Concern about vitamin D was also more common with increasing latitude. Use of novel item response theory analysis highlighted the potential impact of self‐reported behavior change on skin cancer predisposition due concern to vitamin. This cross‐sectional study shows that the strongest determinants of self‐reported sun‐protection behavior changes due to concerns about vitamin D were attitudes and location, with people at higher latitudes worrying more.     

Serum vitamin D levels in office workers in a subtropical climate

Vitamin D is necessary to maintain healthy bones, and may prevent other chronic diseases. There is limited information regarding the vitamin D status of people living in climates with relatively high ambient ultraviolet radiation. We therefore aimed to determine serum 25(OH)D levels in a group of office-workers in subtropical Australia. We collected blood from 129 office workers in summer (n = 129) and 175 in winter (91 in both seasons). Serum 25(OH)D was estimated using a commercial chemiluminescent immunoassay and we asked participants to complete questionnaires about sun exposure and diet for the month prior to blood collection. Summer and winter mean serum 25(OH)D was 74 (95% CI 70-77) nmol L(-1) and 54 (95% CI 51-57) nmol L(-1), respectively. In summer, 14% of participants were classed as "insufficient," compared with 51% in winter. High 25(OH)D levels in summer were associated with time spent outdoors in nonpeak UV periods, while in winter high levels were associated with intake of vitamin D from food or supplements. The high prevalence of vitamin D insufficiency observed in this population highlights the need for further examination of the relation between sunlight and vitamin D production to enable more accurate sun exposure recommendations.     

Solar UV Exposure of Seafarers along Subtropical and Tropical Shipping Routes

Seafarers working on decks of vessels at low latitudes are exposed to extremely high solar UV radiation. Their risk of developing skin cancer may be enhanced. Solar erythemal UV irradiance and exposure were measured for the first time on merchant vessels going along typical international routes at low latitudes. The measurements taken at horizontal incidence on the observation deck, and on different parts of the seaman (head, shoulder, chest and back) doing typical outdoor work show the highest portion (40–80% of horizontal exposure) incident on the head. 2 years of measurements of solar UV and VIS/NIR irradiance taken on the mast top of the Research Vessel METEOR were added to the data base. Radiative transfer model calculations were performed along all the routes with satellite‐based input data of ozone and aerosol for clear sky health‐effective radiation including vitamin D3 (VD3). Measured data show extremely high noontime UV index values up to 19 with clear sky, and up to 22 due to cloud scattering. Eight hours erythemal exposure values are more than double of typical midlatitude summer values. Based on the results, an algorithm is presented to derive a seafarer's personal erythemal exposure according to his/her personal record of sea service.     

Sufficient Vitamin D from Casual Sun Exposure?

Next to the adverse effects of solar UV exposure, the beneficial effects mediated by vitamin D₃ have come into the limelight. The question then is “how much sun exposure do we actually need?” Estimates have been made, but the data are not quite adequate. The groups of Drs. Rhodes and Webb bridged the gap between experiments and everyday life by a study in which 109 volunteers were exposed in mid‐winter to simulated solar UV radiation in summertime clothing at dosages of 1.3 SED three times a week. Thus, 90% reached sufficiently high vitamin D statuses (>50 nmol L⁻¹). In this issue, these researchers transpose these experimental exposures in a cabinet to summertime noon exposures of people walking around for about half an hour in open terrain on a clear day in Manchester, UK. This result is an improvement over earlier estimates and shows that casual mid‐day summer sun exposure should indeed suffice.     

Vitamin D status and its associated factors of free living Malay adults in a tropical country, Malaysia

Vitamin D status is influenced by sun exposure, geographic latitude, daily outdoor activities, body surface exposed to sunlight and dietary intakes. Malaysia, is sunny all year round. However, the vitamin D status of this population especially among the healthy and free living adults is not known. Therefore a study of vitamin D status and associated factors was initiated among an existing Malay cohort in Kuala Lumpur. A total of 380 subjects were sampled to have their vitamin D status assessed using 25-hydroxyvitamin D (25(OH)D). A short questionnaire enquiring socio-demographic characteristics, exposure to sunlight and clothing style was administered. Their mean age was 48.5±5.2years and the mean 25(OH)D for males and females were 56.2±18.9nmol/L and 36.2±13.4nmol/L respectively. There were significant positive correlation for sun exposure score (r=0.27, p<0.001) and negative correlation for sun protection score (r=-0.41, p<0.001) with 25(OH)D levels. In the logistic regression model, females (OR=2.93; 95% CI: 1.17, 7.31), BMI (1.1; 1.03, 1.20) and sun exposure score (0.998; 0.996, 0.999) were significantly associated with vitamin D status as represented by 25(OH)D levels. Our findings show that obesity, lifestyle behaviours and clothing style are directly associated with our participants especially females' low vitamin D status.     

Phytochemicals for the Prevention of Photocarcinogenesis

Ultraviolet (UV) exposure has an array of damaging effects and is the main cause of skin cancer in humans. Nonmelanoma skin cancer (NMSC), including basal cell carcinoma and squamous cell carcinoma, is the most common type of cancer. Incidence of NMSC has increased due to greater UV radiation, increased life expectancy and other changes in lifestyle; the annual cost of skin cancer treatment in the United States has increased concurrently to around eight billion dollars. Because of these trends, novel approaches to skin cancer prevention have become an important area of research to decrease skin cancer morbidity and defray the costs associated with treatment. Chemoprevention aims to prevent or delay the development of skin cancer through the use of phytochemicals. Use of phytochemicals as chemopreventive agents has gained attention due to their low toxicity and anticarcinogenic properties. Phytochemicals also exhibit antioxidant, anti‐inflammatory and antiproliferative effects which support their use as chemopreventive agents, particularly for skin cancer. Preclinical and human studies have shown that phytochemicals decrease UV‐induced skin damage and photocarcinogenesis. In this review article, we discuss the selected phytochemicals that may prevent or delay UV‐induced carcinogenesis and highlight their potential use for skin protection.     

Association of Increased Sun Exposure Over the Life‐course with a Reduced Risk of Juvenile Idiopathic Arthritis

Cutaneous sun exposure is an important determinant of circulating vitamin D. Both sun exposure and vitamin D have been inversely associated with risk of autoimmune disease. In juvenile idiopathic arthritis (JIA), low circulating vitamin D appears common, but disease‐related behavioral changes may have influenced sun exposure. We therefore aimed to determine whether predisease sun exposure is associated with JIA. Using validated questionnaires, we retrospectively measured sun exposure for 202 Caucasian JIA case–control pairs born in Victoria Australia, matched for birth year and time of recruitment. Measures included maternal sun exposure at 12 weeks of pregnancy and child sun exposure across the life‐course prediagnosis. We converted exposure to UVR dose and looked for case–control differences using logistic regression, adjusting for potential confounders. Higher cumulative prediagnosis UVR exposure was associated with reduced risk of JIA, with a clear dose–response relationship (trend P = 0.04). UVR exposure at 12 weeks of pregnancy was similarly inversely associated with JIA (trend P = 0.011). Associations were robust to sensitivity analyses for prediagnosis behavioral changes, disease duration and knowledge of the hypothesis. Our data indicate that lower UVR exposure may increase JIA risk. This may be through decreased circulating vitamin D, but prospective studies are required to confirm this.